Medical Claims Repricer

The following job description is a general outline of essential and common functions related to the performance of your job.  All employees of USA Quality Staffing are expected as a condition of employment to perform tasks as assigned by management whether included in your job description or not.

Supervisor

          VP of Repricing

Job Classification

          Office/Clerical

          Non-exempt

Job Summary

To process hospital and physician medical claims in an accurate and timely time frame.

Job Responsibilities

·       Accurately reprice all medical claims (both Physical & EDI0.

·       Read UB_92 and HCFA form to complete the repricing process.

·       Verify the accuracy of al OPEN and REJECTED control numbers.

·       Identify and document any and all errors identified in the OCR process or processing.

·       Verify provider system information to ensure proper quality control measures are taken.

·       Forward all provider discrepancies to Quality Control for verification.

·       Reprice and return all claims to client within contractual requirements.

·       Cross train in other departments as requested by management.

·       Reprice all medical claims to consistently meet production and accuracy quotas.

• Adhere to USA Managed Care Organization’s Information Security Policies and Procedures
• Adhere to HIPAA Guidelines and Requirements

Qualifications

·       Must be able to reprice a minimum of 250 claims per day with an accuracy rate of no less than 98% by the end of first 90 days of employment.

·       High school graduate or equivalent.

·       ICD9 and CPT4 coding, medical terminology with a minimum of 2 years prior claims processing experience.

·       Familiarity with AS400 and PPO’s a plus.

·       Must be detail oriented.

Physical Requirements

Requires sight and mobility to effectively operate various office machinery including but not limited to computers, telephone, copier, etc.  Must also be able to stand or sit for long periods throughout the day.  Computer/keyboard activity averages over 2/3 of time each day.  Sight requirements include close (clear vision at 20 inches or less), distance (clear vision at 20 feet or more), and ability to adjust the eyes to bring an object into sharp focus.  These requirements result from the demands of reading reports, information and working with computers.  Talking/hearing activity averages over 2.3 of time each day.

Telecommute

          No